Project Narrative Diabetic retinopathy is a feared complication of diabetes and an important cause of blindness in veterans. The VA, through the Office of Care Coordination, has been rapidly moving to teleretinal screening for all veterans with diabetes, using digital cameras and certified independent licensed practitioners as readers. Expert reading suffers from intra-and interobserver reliability, and expert readers are scarce, costly and have high turnover rate. Computer detection has the potential to increase the cost-effectiveness, scalability and sustainability of teleretinal imaging programs while adding a strong dimension to the reading process. However, there remains scepsis within the scientific community and automated lesion detection is unproven in clinical practice. We will compare the performance of human experts, human experts aided by computer and standalone computer on sensitivity, specificity, time to diagnosis, and perform a cost-effectiveness analysis on automated lesion and diabetic retinopathy detection in a prospective clinical trial on a large number of veterans. Dr. Abramoff is Associate Professor of Ophthalmology at the University of Iowa, and is a leader in studies to develop automated systems for evaluation of retinal disease. He has assembled an expert team to assist in this effort, including ophthalmologists, biostatisticians, and experts in telemedicine. 3